Adding MR Diffusion Imaging and T2 Signal Intensity to Neck Imaging Reporting and Data System Categories 2 and 3 in Primary Sites of Postsurgical Oral Cavity Carcinoma Provides Incremental Diagnostic Value

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FIG 1.
Flow chart of the enrolling process of the study and reasons for patient exclusion. OCSCC indicates oral cavity squamous cell carcinoma.
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FIG 2.
ROC comparison curves for ACR NI-RADS, TW2I, DWI, and ADC show the highest diagnostic accuracy with DWI (0.793), followed by ACR NI-RADS (0.768), ADC (0.720), and T2WI (0.536), with a statistically significant difference between DWI and T2WI (P value = .002) and ACR NI-RADS and T2WI (P value = .005).
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FIG 3.
A post-surgically treated case of left buccal mucosa squamous cell carcinoma in a symptomatic 45-year-old male subject with a mild-to-moderate new enhancing lesion in the deep tissue along the superior margin of the flap occult to clinical examination, interpreted as NI-RADS 2. Corresponding ADC shows low values (<1.3 × 10⁻³mm²/s) with intermediate gray T2WI. It was a histopathologically-confirmed malignancy.

Table 2:

Diagnostic parameters for different criteria included in the study

Criteria	Specificity	Sensitivity	PPV	NPV	Accuracy
NI-RADS	78.3	75.4	90.1%	54.5%	76.1%
NI-RADS A	81.2	79.1	91.9%	59.1%	79.6%
NI-RADS B	72.7	88.9	91.4%	66.7%	85.1%
ADC	56.5	88.5	84.3%	65.1%	79.7%
DWI	78.3	80.3	90.7%	60.1%	79.7%
T2 signal	65.2	60.7	82.2%	38.5%	61.9%